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460 Recipient Committee Campaign Statement 10-19-14 to 12-31-14 Semi-AnnualRecipient Committee Campaign Statement Cover Page (Government Code Sections 84200- 84216.5) SEE iNSTRUCTIONS ON REVERSE Type or print in ink. Statement covers period Date of election if applicable from 10/19/2014 (Month, bay, Year) through 12/31/2014 I 11/4/2014 1. Type of Recipient Committee: All Committees — Complete Parts 1, 2, 3, and a. 1 2. Type of ® Officeholder, Candidate Controlled Committee ❑ Q State Candidate Election Committee Q Recall (Also Complete Part 5) ❑ General Purpose Committee Q Sponsored 0 Small Contributor Committee a Political Party /Central Committee COVER PAGE Date Stamp 1)atp. Received ,SAN 2 3 9r?i� 1 s Page of For Offcial Use Only processed bY Ballot Measure Committee ❑ Preelection Statement ❑ Quarterly Statement O Primarily Formed ® Semi - annual Statement ❑ Special Odd Year Report • Controlled ❑ Termination Statement • Sponsored ❑ Supplemental Preelection (Alsocomprete Part 6) ❑ Amendment (Explain below) Statement - Attach Form 495 ❑ Primarily Formed Candidatel Officeholder Committee (Also Complete Part 7) 3. Committee Information LD NUMBER 1369332 COMMITTEE NAME (OR CANDIDATE'S NAME IF NO COMMITTEE) MC COY FOR COUNCIL 2014, ROBERT STREET ADDRESS (NO P.O. BOX) MAILING ADDRESS (iF DIFFERENT} NO. AND STREET OR P.O. HOX CITY STATE ZfP CODE AREA CODEIPHONE OPTIONAL: FAX I E -MAIL ADDRESS Treasurer(s) NAME OF TREASURER Blossom McCoy MAILING ADDRESS NAME OF ASSISTANT TREASURER. IF ANY MAILING ADDRESS CITY STATE ZIP CODE AREA CODEIPHONE OPTIONAL: FAX I E -MAIL ADDRESS 4, Verification I have used all reasonable diligence in preparing and reviewing this statement and to the best of my knowledge the information contained herein and in the attached schedules is true and complete. I certify under penalty of perjury under the laws of the State of California that the foreocina is trua Executed on 01/22/2015 Date Executed on 01/22/2015 Data Executed on Date By By By Signature ofContro €ling Officeholder, Candidate, State Measure Proponent Executed on By Date SignatureafControllingOfficeholder, Candidate.StateMeasureProponent FPPC Form 460 (June /01) FPPC Toll -Free Helpline: 8661ASK -FPPC State of California Recipient Committee Type or print in ink. COVER PAGE - PART 2 Campaign Statement CALIFORNfA Cover Page — Part 2 FORM • 5. Officeholder or Candidate Controlled Committee NAME OF OFFICEHOLDER OR CANDIDATE Robert McCoy OFFICE SOUGHT OR HELD (INCLUDE LOCATION AND DISTRICT NUMBER IF APPLICABLE) Cupertino City Council RESIDENTIALIBUSINESS ADDRESS (NO. AND STREET) CITY STATE ZIP Related Committees Not Included in this Statement: List any committees not included in this statement that are controlled by you or are primarily formed to receive contributions or make expenditures on behalf of your candidacy. COMMITTEENAME I.D. NUMBER NAME OF TREASURER CONTROLLED COMMITTEE? ❑ YES ❑ NO COMMITTEE ADDRESS STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE /PHONE COMMITTEE NAME J.D. NUMBER NAME OF TREASURER CONTROLLED COMMITTEE? [] YES ❑ NO COMMITTEE ADDRESS STREET ADDRESS (NO P.O. BOX) Page 2 of 8 6. Ballot Measure Committee NAME OF BALLOT MEASURE BALLOT NO. OR LETTER JURISDICTION [] SUPPORT ❑ OPPOSE Identify the controlling officeholder, candidate, or state measure proponent, if any. NAME OF OFFICEHOLDER, CANDIDATE, OR PROPONENT OFFICE SOUGHT OR HELD DISTRICT NO. IF ANY 7. Primarily Formed Committee List names of officeholder(s) or candidates) for which this committee is primarily formed. NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD ❑ SUPPORT [] OPPOSE NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD ❑ SUPPORT ❑ OPPOSE NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD ❑ SUPPORT ❑ OPPOSE NAME OF OFFICEHOLDER OR CAND €DATE OFFICE SOUGHT OR HELD ❑ SUPPORT ❑ OPPOSE Attach continuation sheets if necessary FPPC Form 460 (June101) FPPC Toff-Free Helpline: 8661ASK -FPPC State of California Campaign Disclosure Statement Summary Page SEE INSTRUCTIONS ON REVERSE NAIVit Vl- HLLK MC COY FOR COUNCIL 2014, ROBERT Type or print in ink. Amounts may be rounded to whole dollars. SUMMARY PAGE Statement covers period from _. 10/19/2014 through 12/31/2014 page 3 of 8 Contributions Received Column Column TOTAL THIS PERIOD (TROMATTACHEDSCHEDULES) CALENDAR YEAR TCTALTOWE 1. Monetary Contributions ............ ............................... Schedule A. Line 3 $ 14250.00 $ 29910.00 2. Loans Received ...................... ............................... schedule e, Line 3 - 2000.00 3500 3. SUBTOTAL CASH CONTRIBUTIONS ......................... AddLinesi +2 $ 12250.00 $ 33410.00 4. Nonmonetary Contributions_ ................ ................. Schedule C. Line 3 0.00 700.00 5. TOTAL CONTRIBUTIONS RECEIVED ........................... Add Lines 3 +4 $ 12250.00 $ 34110.00 Expenditures Made 6. Payments Made ........................ ............................... Schedule e, Line 4 $ 18311.31 $ 33102.80 7. Loans Made .................... ............. Schedule H, Line 3 0.00 0.00 8. SUBTOTAL CASH PAYMENTS ..... ............................... Add Lines 6 + 7 $ 18311.31 $ 33102.8 9. Accrued Expenses (Unpaid Bills) ............................... Schedule F Line 3 0.00 0.00 10. Nonmonetary Adjustment ......... ............................... Schedule C, Line 3 0.00 OM 11. TOTAL EXPENDITURES MADE . ............................... Add Lines 8 + s + 1 o $ 18311.31 g 34227.80 Current Cash Statement 12. Beginning Cash Balance ....................... Previous summery Page, Line 16 $ 13. Cash Receipts .................... ............................... Column A, Line 3 above 14. Miscellaneous Increases to Cash ........................... Schedule 1, Line 4 15. Cash Payments .............................. ....... Cclumn A, Line 8 above 16. ENDING CASH BALANCE .......... Add Lines 12 + 13 + 14, then subtrect Line 15 $ If this is a termination statement, Line 96 must be zero. 17. LOAN GUARANTEES RECEIVED., .................... Schedule B. Part 2 $ Cash Equivalents and Outstanding Debts 18. Cash Equivalents ................. ... See instructions on reverse $ 19. Outstanding Debts ......................... Add Line 2 + Line 9 in Column B above $ 6368.51 12250.00 0.00 18311.31 307.20 0.00 0.00 0.00 To calculate Column B, add amounts in Column A to the corresponding amounts from Column B of your last report. Some amounts in Column A may be negative figures that should be subtracted from previous period amounts. If this is the first report being filed for this calendar year, only carry over the amounts from Lines 2, 7, and 9 (if any). ID- NUMBER 1369332 Calendar Year Summary for Candidates Running in Both the State Primary and General Elections 111 through 6130 711 to Date 20. Contributions 0 00 Received $ $ 21. Expenditures Made $ 0•00 � Expenditure Limit Summary for State Candidates 22. Cumulative Expenditures Made' (Ifsubject to Voluntary Expenditure Limit) Date of Election Total to Date (mmlddlyy) $ $ $ - ......_._�/ $ 'Since January t, 2001. Amounts in this section may be different from amounts reported in Column B. FPPC Form 460 (Junel0l) FPPC Toll -Free Helpline: 866 /A$K -FPPC Schedule A Monetary Contributions Received SEE INSTRUCTIONS ON REVERSE Type or print in ink. Amounts may be rounded to whole dollars. .ninc yr rnLMM - MC COY FOR COUNCIL 2014, ROBERT DATE FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR RECEIVED ( IFCOMMETTEE ,ALSOENTERI.D.NUMBER) CODE 10/27/2014 Meei Hwa Huang KIND 23261 Partridge Lane ❑coM Los Altos Hills, CA 94024 ❑ OTH ❑ PTY ❑ SCC 10/27/2014 Wen Chun Yu KIND 10200 Miller Avenue #322 ❑coM Cupertino, CA 95014 ❑ OTH C1 PTY ❑ ScC 10/27/2014 Yuhuan Cao KIND 1635 Ontario Drive ❑COM Sunnyvale, CA 94087 ❑ OTH ❑ PTY ❑see 1012812 014 Paul and Eddies Asso Inc ❑IND 21710 Stevens Creek Blvd #200 ❑coM Cupertino, CA 95014 910TH ❑ P-ry ❑ SCC 10/28/2014 Mark Tersini KIND 111 Lasuen Court ❑coM Los Gatos, CA 95032 ❑ OTH ❑ PTY ❑ SCC Schedule A Summary 1. Amount received this period — contributions of $100 or more. (Include all Schedule A subtotals,) ............ 2. Amount received this period — unitemized contributions of less than $100.......... 3. Total monetary contributions received this period. (Add Lines 1 and 2. Enter here and on the Summary Page, Column A, Line 1.) . IP AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER (IF SELF - EMPLOYED, ENTER NAME OF BUSINESS) Homemaker Retired Homemaker Self employed KT Properties Statement covers period + •' from 10/19/2014 FORM through 12/31/2014 page 4 AMOUNT RECEIVED THIS PERIOD I.D. NUMBER 1369332 SCHEDULE A of r., CUMULATIVE TO DATE PER ELECTION CALENDAR YEAR TO DATE (JAN.1 -DEC. 31) (IF REQUIRED) 1000.00 1 1000.00 1000.00 � 1000.00 1000.00 1 1000.00 2500.00 I 2500.00 2500.00 1 2500.00 SUBTOTAL $ 14250.00 TOTAL, $ 14250.00 0 14250.00 *Contributor Codes IND — Individual COM— Recipient Committee (other than PTY or SCC) OTH — Other PTY —Political Party SCC — Small Contributor Committee FPPC Form 460 (June /01) FPPC Toll -Free Helpline: 866/ASK-FPPC Schedule A (Continuation Sheet) Monetary Contributions Received lm ymG Vr FlLCK MC COY FOR COUNCIL 2014, ROBERT Type or print in ink. Amounts may be rounded to whole dollars. DATE FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL, ENTER RECEIVED (IF COMMITTEE, ALSO ENTER 10. NUMBER) OCCUPATION AND EMPLOYER CODE * (IF SELF- EMPLOYED, ENTER NAMF OF BUSINESS) 11/8/2014 Harvest Properties ❑IND 20863 Stevens Creek Blvd #480 ❑COM Cupertino, CA 95014 OTH ❑ PTY ❑ SOC 11/10/2014 Sand Hill Properties ❑IND 2882 Sand Hill Road Suite 241 ❑Coo Menlo Park, CA 94025 ® OTH ❑ PTY ❑ SCC 11/12/2014 Jeanne Anderson MIND 10451 Tula Lane ❑coM Cupertino, CA 95014 F-7 OTH ❑PTY ❑ SCC 10/20/2014 SD Nandakumar MIND 22342 Regnart Road ❑COM Cupertino, CA 95014 ❑ OTH Pte, ❑scc ❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC r "Contributor Codes IND — Individual COM — Recipient Committee (other than PTY or SCC) OTH — Other PTY— Political Party SCC — Small Contributor Committee VP of Operations KT Properties Self Employed Consulting SUBTOTAL$ Statement covers period from 10119/2014 through SCHEDULE A (CONT.) 12/31/2014 Pa 5 ¢ 8 AMOUNT RECEIVED THIS PERIOD 750.00 1000.00 2500.00 2000,00 6250.00 ge o I.D. NUMBER 1369332 CUMULATIVE TO HATE PER ELECTION CALENDAR YEAR TO DATE (JAN. 1 -DEC. 31) (IF REQUIRED) 750.00 1000.00 2500.00 2000.00 FPPC Form 460 (June/01) FPPC Toll -Free Helpline: 8661ASK -FPPC Schedule B — Part 1 Type or print in ink. Amounts may be rounded Loans Received to whole dollars. SEE INSTRUCTIONS ON REVERSE NAME OF FILER MC COY FOR COUNCIL 2014, ROBERT FULL NAME, STREET ADDRESS AND ZIP CODE OF LENDER (iF OOM M ITTEF, ALSO ENTER I, b. NUMBER) Blossom McCoy t® IND ❑ COM C3 OTH ❑ PTY ❑ SCC t❑ IND © COM ❑ OTH ❑ PTY ❑ SCC T❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC SCHEDULE B -PART1 Statement covers period from 10/19/2014 through 1213112014 Page 6 of 8 ID, NUMBER 1369332 IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER (IESe ION ovEn,ENTER NAME OF BUSINESS) tar OUTSTANDING BALANCE BEGINNING THIS PERIOD (b) AMOUNT RECEIVED THIS PERIOD (0 AMOUNT PAID OR FORGIVEN THIS PERIOD" (d) OUTSTANDING BAtANCEAT CLOSE OF THIS PERIOD fey INTEREST PAID THIS PERIOD ORIGINAL AMOUNTOF LOAN (g) CUMULATIVE CONTRIBUTIONS TO DATE CALENDAR YEAR Manager ® PAID Ben Shyy DDS 5 2000.00 3500.00 0 ❑ FORGIVEN PER ELECTION ' RAT E $ 5500.00 12/30/2015 DATE DUE DATE INCURRED ❑ PAID CALENDARYEAR 5 $ % $ $ ❑ FORGIVEN PER ELECTION"" RATE DATE DUE DATE INCURRED 5 SUBTOTALS $ ❑ PAID 5 ❑ FORGIVEN 5 g DATE DUE 0 $ 2000.00 $ 3500,00 $ Schedule B Summary 1. Loans received this period ................. $ 0 (Total Column (b) plus unitemized loans less than $100.) 2. Loans paid or forgiven this period ................. 2000.00 (Total Column (c) plus loans under $100 paid or forgiven.) (include loans paid by a third party that are also itemized on Schedule A.) 3. Net change this period. (Subtract Line 2 from Line 1.) ................... NET $ - 2000.00 Enter the net here and on the Summary Page, Column A, Line 2. (May be a negative number) # Contributor Codes IND—Individual COM — Recipient Committee (other than PTY or SCC) OTH — Other PTY— Political Party SCC —Small Contributor Committee CALENDARYEAR % $ 5 RATE PERELECTION"" $ g DATE INCURRED 0 (Enter (e) an Schedule E, Line 3) `Amounts forgiven or paid by another party also must be reported on Schedule A. If required. FPPC Form 460 (June /01) FPPC Toll -Free Helpline: 8661ASK -FPPC Schedule E Payments Made SEE INSTRUCTIONS ON REVERSE rvnivic Vr riLLN MC COY FOR COUNCIL 2014, ROBERT Type or print in ink. Amounts may be rounded to whole dollars. Statement covers period from 10/19/2014 through 12/31/2014 SCHEDULE Page 7 of 8 ID NUMBER 1369332 CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. CMP CNS campaign paraphernalialmisc. campaign consultants MBR member communications RAD radio airtime and production costs CTB contribution (explain nonmonetary)` MTG OFC meetings and appearances office expenses RFD returned contributions CVC civic donations PET petition circulating SAL TEL campaign workers' salaries FIL candidate filing /ballot fees PHO phone banks t,v. or cable airtime and production costs FND IND fundraising events independent expenditure supportinglopposing others (explain)' POL POS polling and survey research TRC TRS candidate travel, lodging, and meals stafflspouse travel, lodging, and meals LEG legal defense postage, delivery and messenger services TSF transfer between committees of the same candidate /sponsor UT campaign literature and mailings PRO PRT professional services (legal, accounting) VOT voter registration print ads WEB information technology costs (internet, e-mail) NAME AND ADDRESS OF PAYEE (TFCOMM17FE, ALSOENTER E.o_ NUWeER} CODE OR DESGRIPTON OF PAYMENT Akido Printing World Journal Target * Payments that are contributions or independent expenditures must also be summarized on Schedule D. Schedule E Summary 1. Payments made this period of $100 or more. (include all Schedule E subtotals.) ....................... ................ ............................... 2. Unitemized payments made this period of under $100 ............... . 3. Total interest paid this period on loans. (Enter amount from Schedule B, Part 1, Column (e),) ............... 4. Total payments made this period. (Add Lines 1, 2, and 3. Enter here and on the Summary Page, Column A, Line 6.) .......... . SUBTOTAL$ TOTAL $ AMOUNT PAID 16731.96 1242.00 256.39 18230.35 18311.31 0 0 18311.31 FPPC Form 460 (June /01) FPPC Toll -Free Helpline: 866/ASK-FPPC Schedule E (Continuation Sheet) Payments Made SEE INSTRUCTIONS ON R NAME OF FILER MC COY FOR COUNCIL 2014, ROBERT Type or print in ink. Amounts may be rounded to whole dollars. Statement covers period from 10/1912014 through 12/31/2014 SCHEDULE E (CONT.) C:ALI RMNfA 4 60 Page 8 of 8 FORM v f_D.NUMBER 1369332 CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. CW CNS campaign paraphemalialmisc. campaign consultants MBR member communications RAD radio airtime and production costs CTl3 contribution (explain nonmonetary)' MTG OFC meetings and appearances office expenses RFD returned contributions CVC FIL civic donations candidate filing /ballot fees PET petition circulating SAL TEL campaign workers' salaries t.v. or cable airtime and production costs FND fundraising events PHO POL phone banks TRC candidate travel, lodging, and meals IND independent expenditure supportinglopposing others (explain)} POS polling and survey research postage, delivery and messenger services TRS TSF staff /spouse travel, lodging, and meals LEG legal defense PRO transfer between committees of the same candidate /sponsor LIT campaign literature and mailings PRT professional services (legal, accounting) print ads VOT voter registration WEB information technology costs (internet, e-mail) NAME AND ADDRESS OF PAYEE (1F COMM InEE, ALSO ENTER I.D. NUMBER( Costoo.com Secretary of State CODE OR DESCRIPTION OF PAYMENT OFC FIL * Payments that are contributions or independent expenditures mustalso be summarized on Schedule D, AMOUNT PAID 30.96 K1 t 1 SUBTOTAL $ 80,96 FPPC Form 460 (.tune /01) FPPC Toll -Free Helpline: 866 /ASK -FPPC